Hackensack Meridian Health and Englewood Health have signed a definitive agreement to merge, the not-for-profit New Jersey health system and hospital announced Tuesday.
Hackensack pledged a $400 million capital investment in Englewood, which executives hope will further Englewood's position as a tertiary academic hub in northern New Jersey. Those investments include new operating rooms, additional ambulatory care facilities and expanded cardiac catheterization labs, among others.
State and federal officials will need to sign off on the deal, which is expected to be completed in a year.
"We recognize that more and more healthcare is delivered outside of the four walls of a hospital," said Robert Garrett, CEO of Hackensack Meridian Health.
An expanded ambulatory network will increase access and lower costs, he added.
Hackensack, which has 17 hospitals and an affiliation with Memorial Sloan Kettering Cancer Center, has had a clinical and academic partnership with Englewood since 2015. Englewood Health includes Englewood Health Physician Network, Englewood Health Foundation and Englewood Hospital and Medical Center, which deliver cardiovascular care, neurosciences, oncology, robotic surgery, women's health and neonatal intensive care, stroke care, thoracic surgery and ambulatory care. They both operate on the Epic electronic health record.
"Hackensack recently opened its first behavioral health urgent care center—those are areas where on your own you could really just scratch the surface, but together you can make the investments necessary to create access and address affordability at the same time," said Warren Geller, president and CEO of Englewood Health.
Hackensack and Englewood plan to create a regional cardiac surgery program, but that doesn't mean those services will cease at Englewood, Geller said. It means they will link the patient to the right care in the most effective setting, he said.
The number of independent hospitals, in New Jersey and across the country, continues to wane. Nearly three-quarters of all hospitals were part of multihospital systems in 2017, up from 70.4% in 2012, according to Modern Healthcare Metrics data.
Lower reimbursement rates, declining inpatient admissions, and higher staffing, pharmaceutical and technology costs are weakening margins. More than half the nation's stand-alone hospitals (53.2%) have lost money on an operating basis each year spanning 2012 to 2017, which is more than twice the share of system-owned hospitals (25.9%), Metrics data show.
Meanwhile, health systems are looking to acquire hospitals in the same or adjacent markets as they claim that scale is necessary to contain costs, improve access to capital, bolster care and boost their leverage with payers and vendors. Economists maintain that health systems often raise prices following mergers and so-called efficiencies are seldom reached given the complexity of integration.
"There is no question that many of the independent hospitals in New Jersey have either merged with a larger health network or affiliated to receive the benefits that a large network can bring," Garrett said, citing potential supply chain savings, better pricing on drugs and supplies, and clinical alignment. But one size does not fit all, he added.
Hackensack, which formed a clinical partnership with St. Joseph's Health last month, reported an operating income of $274.4 million on revenue of $5.4 billion in 2018, down from $228.2 million of operating income on $4.4 billion of revenue in 2017, according to Modern Healthcare's financial database.
Englewood's operating revenue was cut in half in 2018, dropping to $14.5 million on operating revenue of $665.9 million. It reported $32.5 million in operating revenue on $629.9 million of operating revenue in 2017.